Economic Analysis Of Various Radiotherapy Treatment Delivery Methods
Treatment techniques have evolved over the course of many years as a result of the technologic advancement. Improvements in treatment planning software as well as linear accelerators have allowed treatment techniques to transition from 2-dimensional treatment plans and techniques to 3-dimenesional treatment plans and then to IMRT. The increased work necessary for physicians, dosimetrists, and physicists needed to design and perform quality assurance resulted in increased reimbursement, both on the professional and technical sides. The development and implementation of IMRT was made possible by the further improvements in treatment planning software and linear accelerators, with the advent of multi-leaf collimators. IMRT treatment techniques, as reported elsewhere in this issue, made it possible to escalate the delivered radiotherapy dose while reducing both acute and late toxicity. The increased in delivered radiotherapy dose resulted in higher biochemical disease-free survival . IMRT was rapidly adopted as the standard of care in the treatment of prostate cancer because of these results without randomized clinical trials comparing IMRT to 3D conformal radiotherapy . Reimbursements for IMRT, however, were considerable higher when compared to 3DCRT dramatically increasing the overall cost of care for prostate cancer. Economic analyses using decision models were performed to provide evidence of cost-effectiveness of IMRT compared to 3DCRT.
Surgically Removing The Prostate Gland
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.
Like any operation, this surgery carries some risks.
A recent trial showed possible long-term side effects of radical prostatectomy may include an inability to get an erection and urinary incontinence.
Before having any treatment, 67% of men said they could get erections firm enough for intercourse.
When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.
For urinary incontinence, 1% of men said they used absorbent pads before having any treatment.
When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.
Out of the men who were actively monitored instead, 4% were using absorbent pads at 6 months and 8% after 6 years.
In extremely rare cases, problems arising after surgery can be fatal.
Itâs possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.
Why would I choose radiation therapy?
How should I expect to feel during radiation therapy?
Which Treatment Is Best For You
The exact type of treatment that is best for you can depend upon many factors, such as the stage of the cancer, where in the prostate the cancer is located, and individual factors. These are all taken into account by the treating healthcare team when creating a personalized treatment plan.
When you meet with your healthcare provider, they will give you the options that will be the most effective in treating your case of prostate cancer.
For stage 1 prostate cancer, treatment may include:
- Watchful waiting or active surveillance
- Hormone therapy
- Radical prostatectomy with pelvic lymphadenectomy
- Radiation after surgery
- Transurethral resection of the prostate
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Diarrhea Flatulence Or Painful Defecation
These symptoms usually occur after the second or third week of treatment. Symptoms will resolve after the treatment ends. During radiation, dietary modification usually helps reduce the frequency and severity of diarrhea. Try to avoid or reduce fried foods, greasy foods and highly spiced foods. Reduce foods with insoluble fiber, such as lettuce and cauliflower, and increase low-fiber and soluable-fiber foods, such as bananas, mashed potatoes, applesauce, white rice, canned or cooked fruits and vegetables.
Maintain your intake of lean proteins, such as turkey, chicken and fish, and increase your fluid intake to avoid dehydration. Using moist toilet paper, baby wipes or sitz baths may help relieve rectal irritation. Your doctor may recommend anti-diarrheal medications. Contact your doctor if you see blood in your stool, if the diarrhea worsens or if you become light-headed or dizzy.
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Design Setting And Participants
We used clinical electronic health records for 20082018 linked with the California Cancer Registry and the Medicare Fee Schedule to assess costs over 24 or 60 mo following diagnosis. We identified surgery or radiation treatments with structured methods, while we used both structured data and natural language processing to identify AS.
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Symptomatic treatment of an enlarged prostate usually involves a combination of medication and lifestyle changes. A diet rich in fruits and vegetables may be the best option if you suffer from chronic urination. It will help the body adjust to the increased size of the prostate. Also, taking regular urination intervals will help retrain the bladder to function properly. Inactivity also contributes to urine retention, and cold temperatures can increase the urge to urinate.
Invasive treatment of enlarged prostate includes medication that relieves the pressure on the urethra and bladder. However, if the condition is severe, it may require surgical intervention. If treatment is not successful, the enlarged prostate can become a potentially life-threatening disease. As the hormone levels in the body change, the enlarged prostate can lead to various complications, including urinary retention and even cancer. This is why it is critical to see a doctor for further evaluation.
When Is Brachytherapy Alone The Right Choice
For some patients with disease that is confined to the prostate and not too aggressive , brachytherapy alone is a good option. It is also convenient for the patient as it is done in an outpatient setting and most people can get back to work within a few days.
But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would be preferred. At MSK, our philosophy is that when the disease is caught very early, it is very appropriate to do active surveillance and hold off on treatment.
This philosophy applies to patients with a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease. There are also very select patients with Gleason 7 disease who may be candidates for active surveillance.
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Intensity Modulated Radiation Therapy
IMRT, an advanced form of 3D-CRT therapy, is the most common type of external beam radiation therapy for prostate cancer. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the prostate from several angles, the intensity of the beams can be adjusted to limit the doses of radiation reaching nearby normal tissues. This lets doctors deliver an even higher radiation dose to the cancer.
Some newer radiation machines have imaging scanners built into them. This advance, known as image guided radiation therapy , lets the doctor take pictures of the prostate just before giving the radiation to make minor adjustments in aiming. This appears to help deliver the radiation even more precisely and results in fewer side effects.
A variation of IMRT is called volumetric modulated arc therapy . It uses a machine that delivers radiation quickly as it rotates once around the body. This allows each treatment to be given over just a few minutes. Although this can be more convenient for the patient, it hasnt yet been shown to be more effective than regular IMRT.
What Are The Costs Associated With Radiation Therapy
Radiation therapy treatment at public or partnership radiation therapy centres is generally provided without a cost to the patient.
Radiation therapy at a private centre may incur out of pocket costs, also known as a gap or gap payment. This is the difference between the cost of treatment and Medicare rebate. You are required to pay the full cost yourself before you can claim a rebate from Medicare.
Any direct costs charged by a radiation therapy centre, Medicare rebates applicable to you and any out of pocket costs that you will need to pay must be made clear to you before treatment begins.
You will also need to confirm with the radiation therapy centre what other costs you are likely to need to pay as part of your overall treatment and recovery. Allied health care providers may be free of charge in the public system or may incur a cost if they are private providers. Your doctor or the radiation therapy centre may be able to advise you about your eligibility for government assistance for travel and accommodation.
You have the right to choose the radiation therapy centre who will provide your treatment based on your needs and considering all the costs involved. Many radiation therapy centres have accounts staff to talk you through these considerations.
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Side Effects Of Radiation Therapy
Compared to earlier radiation methods, these modern techniques reduce the chance of urinary and bowel problems.
With several treatment options available, your doctor will work with you to develop and oversee a treatment plan that precisely addresses your prostate cancer while minimizing the risk to surrounding tissues.
This is why it is important to choose an experienced radiation oncologist who specializes in the management of prostate cancer. High volume centers where practitioners have significant experience and treat large numbers of patients with prostate cancer may be associated with good outcomes and fewer lasting problems related to treatment. The majority of patients who undergo radiation do not have permanent effects on bowel or urinary function, and patients who develop erectile difficulty after these therapies can often be treated successfully with medications such as sildenafil or tadalafil.
Breaking Down The Costs Of Treatment
Dr. Lester understands that the costs of prostate cancer treatment may seem high, especially when patients spend but a few minutes in the treatment room. However, he is quick to point out that its important for patients to understand all the factors that contribute to the expense.
Why is radiation is so costly? Dr. Lester asks. First of all, the treatment room has to protect the personnel and the lay public, who are not in the room, from the radiation because only the patient can be in the room.
The treatment room itself is eight to ten feet of poured concrete at the primary beam. So youre looking at $800,000 to $1 million just for the treatment room and about two to three million dollars for the treatment machine plus all the support services.
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What To Ask About Health Insurance Coverage Of Your Treatment
Out-of-pocket costs are those you have to pay because your health insurance doesnt or after your insurance company has paid its portion. These costs can add up quickly and may make it hard for you to pay for other things you need. Youll want to be sure that your health insurance company pays or reimburses the bulk of your medical expenses. This means youll need to
- Know the terms of your insurance policy.
- Be aware of preferred or network doctors, hospitals, or clinics according to your policy.
- Keep careful records of your health care costs
If any of your treatments might be done by out-of-network doctors or providers, find out about those costs from your insurance company too. Even when you know the terms of your policy, getting payments can mean re-submitting claims, appealing denials, and much more.
Usually, health care facilities and treatment centers have a financial department that handles health insurance concerns and problems. Ask your health care team if someone can help you with claims and understanding codes on the bills that are sent to the insurance company.
You can find out more about health insurance and other costs at Understanding Health Insurance.
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Cost Effectiveness Of Prostate Cancer Radiotherapy
Andre Konski1,2
1Department of Radiation Oncology, University of Pennsylvania, Perelman School of Medicine, Pennsylvania, USA 2Leonard Davis Institute of Health Economics, University of Pennsylvania, Pennsylvania, USA
Correspondence to:
Abstract: The use of radiotherapy in the treatment of prostate cancer has evolved from treatments utilizing large fields with hand placed blocks to radiotherapy treatments given with a linear accelerator moving around the patient on a robotic arm. These technologic developments have allowed radiation dose escalations resulting in improvements in disease and patient reported outcomes with longer biochemical disease-free survival as well as improved quality of life. Increased costs have accompanied these technologic improvements with some private payers questioning the increased cost of the newer treatments and in some instances refusing to pay for some treatment modalities such as intensity-modulated radiotherapy or proton beam therapy . Cost-effectiveness analysis have been used in an attempt to illustrate these new treatments were cost-effective when compared to the older treatments. Cost-effectiveness analyses will need to be adapted in the current health care environment to provide an assessment of value as many payers, including medicare, move to a value-based reimbursement system.
Keywords: Prostate cancer radiotherapy cost-effective
Submitted Nov 14, 2017. Accepted for publication Dec 27, 2017.
doi: 10.21037/tau.2017.12.38
Medical Expenses Of Cancer Treatment
Learn as much as you can about cancer and your cancer treatment before it starts. Remember that each person’s experience and treatment is different. So, learning and asking questions will help you know what to expect for your situation. It can also help you plan for and deal with the costs related to your care.
Many people with cancer have medical expenses for things like:
- Provider office visits
- Specialist referrals
- Transportation costs .
- Some patients need hotels or lodging during treatment. The American Cancer Society might be able to help if you need lodging closer to treatment.
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What Should Patients Know About Msks Approach To Treating Prostate Cancer
At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease. There is no one specific therapy that is best for everyone.
Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. We will often obtain next-generation imaging and do genomic testing. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.
The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are one of the few centers in the world to do MRI-based treatment planning and one of the few centers in the US to offer MRI-guided treatment. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. It requires a great deal of collaboration with our medical physics team to try to get the most accurate positioning of the prostate during the actual three or four minutes of the treatment.
We make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.
Potential Cancer Care Costs
Take some time to think about the possible types of costs that could add up from treatment. This can help you prepare a budget and determine what sort of support you might need. Your personal costs will depend on several factors, including the type of prostate cancer treatment you choose and your health insurance coverage.
Some costs might be more obvious than others. Medication costs based on insurance may be easier to determine depending upon your coverage. There are also other costs to consider. These are the costs of daily living that may be impacted while you are in treatment. If you expect treatment to be completed quickly, you will have different considerations than someone who is planning for long-term treatment for a period of years. Below are some costs to consider.
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All You Need To Know About Radiation Therapy
Radiation therapy, also known as radiotherapy, is a procedure in which ionizing radiation is used as a part of cancer treatment to inhibit or kill the malignant cells in the body.
How much does a Radiation Therapy cost in India?
The average cost of radiation therapy in India is usually between Rs.30,000 to Rs.20,00,000 depending on which type of radiation technique that is recommended. However, the prices may vary depending upon the hospitals in different cities.
What is the average cost of Radiation Therapy in Hyderabad?
The cost of radiation therapy in Hyderabad starts from Rs.1,90,000. Yet, it depends upon multiple factors.
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